Objective To investigate the therapeutic effects of tiotropium in the treatment of stable COPD ( chronic obstructive pulmonary disease) patients of group D. Methods Sixty-two subjects with stable COPD in group D classified by combined COPD assessment in GOLD 2011, were randomly divided into a treatment group ( n = 32) and a control group ( n = 30) . The treatment group was treated with tiotropium ( 18 μg, inhalation, once daily) plus salmeterol /fluticasone ( 50/500 μg, inhalation, twice a day)and the control group was treated only with salmeterol / fluticasone ( 50/500 μg, inhalation, twice a day) . The exercise tolerance, dyspnea score and lung function were measured before and 1, 8,24, and 48 weeks after the treatment respectively. Results 8, 24, 48 weeks after the treatment respectively, there were improvements of 6 minute walk test and the dyspnea score of medical research council scale( MRC) in both groups than before treatment, and which was better in the treatment group. Compared with baseline and the control group, significantly greater improvements in the FVC, FEV1 and FEV1% pred were seen in the treatment group at all time points. In the control group, FVC, FEV1 and FEV1% pred 1 and 8 weeks after treatment were higher than those before treatment, but there was no significant difference after treatment of 24 and 48 weeks.Conclusion Combination treatment with tiotropium and salmeterol / fluticasone inhalation results in greater therapeutic benefits than salmeterol / fluticasone inhalation alone in stable COPD patients of group D.
目的 评价噻托溴铵对不同表型慢性阻塞性肺疾病（COPD）患者的疗效。 方法 选取2008年10月－2010年5月COPD患者81例，根据胸部高分辨率CT上的形态表现分型，以气道病变为主型纳入A组，以肺气肿为主型纳入B组，按方案吸入噻托溴铵，在给药前后分别测定肺功能、圣?乔治呼吸问卷评分（SGRQ）及6 min步行距离。 结果 用药3个月后A组的第1秒用力肺活量（FEV1）、用力肺活量（FVC）、FEV1/FVC及FEV1占预计值（%）比B组明显提高，两组比较差异有统计学意义（P＜0.05），SGRQ评分比较B组明显下降，运动耐力（6 min步行距离）增加（P＜0.05）。 结论 噻托溴铵在COPD的治疗中，针对不同的表型，其疗效不同。
Objective To systematically evaluate the efficacy and safety of tiotropium plus budesonide/formoterol compared with tiotropium in Chinese patients with chronic obstructive pulmonary disease (COPD). Methods PubMed (from 1980 to March, 2015), Wiley Online Library (from 1990 to March, 2015), Elsevier (from 1990 to March, 2015), CNKI(from 1990 to March, 2015), VIP(from 1990 to March, 2015) and WanFang Data(from 1990 to March, 2015) were searched for randomized controlled trials (RCTs) of tiotropium plus budesonide/formoterol compared with tiotropium in treating Chinese patients with COPD from the establishment of the database to March 2015. The quality of included studies was assessed according to Cochrane Methods 5.1 for Systematic Review, and Meta-analysis was conducted by RevMan 5.3 software. Results Atotal of 9 studies involving 503 patients were included. Compared with the tiotropium therapy group, tiotropium plus budesonide/formoterol in treating Chinese patients with COPD can more significantly improve FEV1 (MD=0.10, 95%CI 0.05 to 0.15, P<0.000 01), FEV1%pred (MD=4.27, 95%CI 2.44 to 6.09, P<0.000 01), FEV1/FVC (MD=3.48, 95%CI 3.21 to 3.74, P<0.000 01), mMRC (MD=-0.27, 95%CI -0.38 to -0.17, P<0.000 01), CAT (MD=-0.91, 95%CI -1.74 to -0.08, P=0.03), 6MWT (MD=27.64, 95%CI 11.76 to 37.53, P<0.000 01) and the frequency of repeated exacerbations (OR=0.25, 95%CI 0.08 to 0.76, P=0.01) while no significant difference was found between two groups in SGRQ (MD=-5.11, 95%CI -11.57 to 1.36, P=0.12). There was no significant differences in adverse reaction rates (OR=1.33, 95%CI 0.65 to 2.73, P=0.44) between the tiotropium plus budesonide/formoterol group and the control group. Conclusions Tiotropium plus budesonide/formoterol is effective in treating Chinese patients with COPD. It can effectively improve treatment efficiency and does not increase the incidence of adverse drug reactions. However, due to the limitation of both quantity and quality of included studies, this conclusion should be further confirmed by more high quality and large sample studies.
Objective To systematically evaluate the efficacy and safety of salmeterol/fluticasone combined with tiotropium versus salmeterol/fluticasone alone for Chinese patients with chronic obstructive pulmonary disease (COPD). Methods The databases including PubMed, EMbase, The Cochrane Library (Issue 4, 2017), CNKI, VIP and WanFang Data were electronically searched to collect randomized controlled trials (RCTs) about salmeterol/fluticasone combined with tiotropium vs. salmeterol/fluticasone alone for Chinese COPD patients from inception to April 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of 30 RCTs involving 3 121 Chinese patients were included. The results of meta-analysis showed that, compared with the salmeterol/fluticasone alone group, the salmeterol/fluticasone plus tiotropium group could significantly improve the levels of FEV1[MD=0.30, 95%CI(0.22, 0.39), P<0.000 01], FVC [MD=0.31, 95%CI (0.23, 0.40), P<0.000 01] and FEV1/FVC [MD=9.07, 95%CI (6.69, 11.44), P<0.000 01]. While there was no significant difference in adverse reaction rates between the two groups [OR=1.17, 95%CI (0.83, 1.66), P=0.37]. Conclusions Current evidence shows that salmeterol/fluticasone plus tiotropium can improve lung function in Chinese patients with COPD. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically evaluate the efficacy and safety of budesonide/formoterol combined with tiotropium versus budesonide/formoterol alone for Chinese patients with COPD. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about budesonide/formoterol combined with tiotropium vs. budesonide/formoterol alone for Chinese COPD patients from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. ResultsA total of 15 studies involving 1123 Chinese patients were included. The results of meta-analysis showed that, compared with the budesonide/formoterol alone group, the budesonide/formoterol plus tiotropium group could significantly improve the levels of FEV1 (MD=0.19, 95%CI 0.12 to 0.25, P<0.00001), FVC (MD=0.35, 95%CI 0.14 to 0.57, P=0.001), FEV1% (MD=5.96, 95%CI 4.48 to 7.43, P<0.00001), FEV1% pred (MD=6.82, 95%CI 2.21 to 11.43, P=0.004), FEV1/FVC (MD=7.72, 95%CI 5.69 to 9.75, P<0.00001), mMRC (MD=-0.43, 95%CI -0.52 to -0.33, P<0.00001), CAT (MD=-1.45, 95%CI -2.26 to -0.64, P=0.0005), SGRQ (MD=-7.05, 95%CI -9.16 to -4.94, P<0.00001) and 6MWT (MD=32.52, 95%CI 16.68 to 48.37, P<0.00001). While there was no significant difference in adverse reaction rates between the two groups (OR=1.77, 95%CI 0.79 to 3.98, P=0.16). ConclusionCurrent evidence shows that budesonide/formoterol plus tiotropium can improve lung function and clinical symptom in Chinese patients with COPD. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
目的 观察噻托溴铵治疗慢性阻塞性肺疾病急性加重期（AECOPD）临床疗效与安全性。 方法 选取 2010 年 1 月－2011年12月入院的69例AECOPD 患者随机分为试验组（A组，n=36）和对照组（B组，n=33），A组在B组常规治疗的基础上吸入噻托溴铵。治疗起始及结束分别观察两组肺功能指标、慢性阻塞性肺疾病评估测试（CAT）评分、血气分析、6分钟步行距离、住院时间及药物不良反应。 结果 两组均显示出一定的临床效果，A组治疗后肺功能指标、CAT评分、血气分析、6分钟步行距离均优于B组，差异均具有统计学意义（P＜0.05）。A组住院时间短于B组（P＜0.05），且无严重不良反应。 结论 AECOPD患者在常规治疗同时吸入噻托溴铵，疗效显著且临床安全性较高。
ObjectiveTo investigate the changes of interleukin-8 (IL-8), tumor necrosis factor-α(TNF-α) and phospholipase A2 (PLA2) in serum, bronchoalveolar lavage fluid (BALF) and lung tissue of COPD rats and the effects of tiotropium.To identify the anti-inflammatory function of tiotropium. MethodsRat COPD model was established by passive smoking as well as intratracheal instillation of lipopolysaccharide(LPS).Thirty male SD rats were randomly divided into a control group, a COPD group and a tiotropium bromide treatment group (n=10 in each group).The pathologic changes of the lung tissue and airway were observed by HE staining.The total and differential cell counts in BALF were observed.The levels of IL-8, TNF-α, PLA2 in serum, BALF and lung tissue were measured by enzyme-linked immunosorbent assay. ResultsHE staining revealed that the rat COPD model was successfully established.The COPD group appeared obvious emphysema, while the treatment group appeared mild emphysema.The total inflammatory cells, the proportion of neutrophils and lymphocyte, and the levels of IL-8, TNF-α, PLA2 in serum, BALF and lung tissue in the COPD group were obviously higher than those in the control group (P < 0.01).The total inflammatory cells, the proportion of neutrophils and lymphocyte, and the levels of IL-8, TNF-α, PLA2 in serum, BALF and lung tissue in the treatment group were significantly lower than those in the COPD group but higher than those in the control group (P < 0.01). ConclusionsTiotropium bromide can reduce the levels of IL-8, TNF-α, PLA2 in serum, BALF and lung tissue of COPD rats by reducing the leakage of inflammatory cells, and alleviate the airway inflammation and the degree of emphysema.
Objective To investigate the effect of inhaled anticholinergics on heart rate recovery (HRR) in patients with stable chronic obstructive pulmonary disease (COPD). Methods Sixty clinically stable patients with stage Ⅱ-Ⅳ COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines were recruited. HRR was analyzed in this study between 28 patients who had received tiotropium≥1 year and 32 patients who never used anticholinergics as control, so as to reflect parasympathetic reactivity of the heart. Results HRR was significantly lower in the subjects with tiotropium than that in the controls [(16±6) beats/min vs. (22±8) beats/min, P<0.05]. Multivariate regression analysis revealed that anticholinergics medication could be used as an independent predictor of HRR in the COPD patients. Conclusion Anticholinergics can affect cardiac autonomic function of stable COPD patients.
Objective To observe the effects of salmeterol / fluticasone combined with tiotropium in the treatment of sever to very sever COPD. Methods Eighty patients with severe to very severe stable COPD were recruited from outpatient of Central Hospital of Cangzhou between May 2008 and October 2009. The subjects were randomly divided into a salmeterol /fluticasone group and a combination group. The salmeterol / fluticasone group received salmeterol / fluticasone propionate, and the combination group received the combination therapy of tiotropium and salmeterol / fluticasone propionate. All patients had received the treatment for 12 months. At baseline and at the end of 1-month, 3-month, 6-month, 12-month, lung function ( FEV1 , IC and FVC) , six-minute walk distance and the St. George’s Respiratory Questionnaire ( SGRQ) score were assessed. The number of exacerbations and the time to the first exacerbation were also recorded. Results At every visit, lung function ( FEV1 , IC and FVC) , six-minute walk distance and the SGRQ score were improved in both groups compared with baseline ( Plt;0. 05) , especially in the combination group ( Plt;0.05) . Compared with the salmeterol /fluticason, the combination therapy with tiotropium significantly decreased the incidence of exacerbations and prolonged the time to the first exacerbation ( Plt;0.05) . And there was no significant difference between two groups in adverse effects ( Pgt;0.05) . Conclusions The combination therapy with salmeterol / fluticasone propionate and tiotropium was superior to salmeterol / fluticasone propionate in treatment of sever to very severe stable COPD patients in improving lung function, exercise tolerance, and quality of life, without additional adverse effects.